Hypospadias and epispadias are congenital defects of the penis that result in incomplete development of the anterior urethra. The congenital defect results in an abnormal urethral opening at any place along the shaft of the penis and may even open onto the scrotum or perineum. The incidence of this defect in the United States is approximately 3.2 in 1,000 live male births or about 1 in every 300 male children. The etiology of this defect is unknown but is associated with a higher familial tendency and by race/ethnic background (more common in whites, Italians, and Jews). Chordee, an abnormal curvature of the penis, is frequently associated with hypospadias. Other associated anomalies/diseases include: undescended testes (9%-32%); inguinal hernia (9%-17%); and Wilms' tumor.
The goal of treatment of this defect is to reconstruct a straight penis with a meatus close to the normal anatomic location. Repair is being performed at progressively younger ages to avoid emotional distress in the young child. Currently, the recommended age for repair is between 3 and 12 months (for hypospadias/epispadias or urethroplasty); and during the first year (for chordee repair or orthoplasty). Three objectives of surgical correction of this defect are: to ensure the child's ability to void in the standing position with a straight stream (will minimize child and parent anxiety); to improve the child's physical appearance and ensure a positive body image; and to preserve sexual function.
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